Nursing - Patient Care

Abstract

Flush left for the Abstract only. Nurses provide the majority of one-on-one patient care and are the largest group in the health care setting. Health care is changing rapidly by leaps and bounds and nursing must be prepared to face the challenges approaching upon us. According to the Institute of Medicine (IOM), the Affordable Care Act of 2010 is the single largest piece of legislation that overhauled Medicare and Medicaid since 1965. Today there is an ongoing heated debate over the bachelor of nursing (BSN) degree becoming a mandatory entry level standard for registered nurses. The IOM brought national attention when they recommended that 80 percent of nurses obtain a BSN by 2020. This paper will discuss the pros and cons of the BSN becoming an academic standard for the registered nurse, therefore becoming the entry level requirement.

Very nice overview of the contents of this paper!!

Introduction

From my own nursing experience of fourteen years as an associate degree nurse I have noticed a drastic difference between the associate and bachelors prepared nurses in my hospital. We are a teaching hospital and have an influx of new graduates each summer. The associate degree nurse seems to function and pick up things quicker than the BSN prepared nurse. The BSN prepared nurse struggle with multi-tasking and performing routine skills more so than the ADN. I believe the associate degree nurses are better prepared to perform routine tasks and skills more so than the new BSN nurse who is focused on theory. With that said, it did take me several years to marry the task oriented with a higher level of thinking, but that is owed too many years of experience working the floor, home health and hospice, and the current Director role I am presently in.

Bachelor of Science Nursing Degree

In the early 1990's many health care organizations (HCO) were struggling with entry-level competencies and role transitions, particularly the baccalaureate prepared nurse for staff nursing (Byrd & Anema, 1990). The question left lingering, is a (BSN) important and should it be the entry level standard for registered nurses? I believe associate degree nurses play a vital role in health care settings, but recognize that additional education early in one's career is crucial to moving initiatives for quality care forward. As pointed out by Dr. Haller, associate degree nurses can have strong analytic skills while the BSN training focuses on communication skills and systems thinking, she refers to these two populations as an "overlapping bell curve with regard to competencies and attitudes" (Robert Wood Johnson Foundation Consensus Report, 2010)."

I firmly believe that the BSN is important, with that said, I do agree with the Institute of Medicine and The Robert Wood Johnson Foundations four key messages; "nurses should practice to the full extent of their education and training, nurses should achieve higher levels of education and training through improved education system that promotes academic progression, nurses should be full partners, with physicians and other health care professionals in redesigning health care in the United States that includes better data collection and information infrastructure" (Institute of Medicine, 2010)." For me the question arises, when should an associate degree nurse continue education and training? This much debated question is starting to be answered by many states like California with their initiative BSN by 2010. "California Nurse Leaders developed this initiative to require the baccalaureate in nursing as the credential for entry into practice as a registered nurse" (Barter, M., & McFarland, P. 2001)." Their research states, "when nursing is compared to other health care professions, such as pharmacy, physical therapy, and occupational therapy, it becomes obvious that educational requirements for nurses must be updated therefore, nursing leaders developed a 10-year action plan to change the entry-level educational requirements for California nurses" (Barter, M., & McFarland, P. 2001)." These authors make such an important point!!

Many HCO's have a BSN hiring preferences and are committed to continuing education. Johns Hopkins Hospital, Tenet, and the Veterans Health Administration to mention a few, believe that BSN prepared nurses are "systems thinkers that can identify problems and therefore provide solutions that not only benefit patients but the organization" (Institute of Medicine, 2010)." They believe the BSN degree is important for nurses to have but most HCO's have tight budgets that do not support the preferential hiring of the BSN only nurses. Most HCO's have limited budgets, limited staffing, and frequent leadership turnover that makes their environment less conducive to continuing education. These barriers must be addressed so all HCO's big or small can support an environment that promotes continuing education to push nursing forward across the nation.

Implications for Nursing

This year the Hospital Readmission Reduction Program is underway which means that hospitals with excessive readmissions will have reductions in payments. Hospitals must be armed and ready to provide adequate and extensive patient teaching. Unfortunately, my hospitals readmission rate is one of the highest in the nation and we are not armed with enough system thinkers to reach the Value Based Purchasing measures of success for 2013 and 2014. With this initiative right around the corner expanded initiatives in 2014 include more nurse sensitive measures. What this means for my organizations BSN prepared nurses is that once again they will be overburdened and probably end up leaving to go work at the hospital down the road that only hires BSN prepared nurses. I have to ask myself, with all the new mandatory regulatory requirements, why has it taken so long to promote education progression for registered nurses across the Nation? The time for more BSN prepared nurses is now in the state of Oklahoma and clearly the answer is that our voices are not loud enough. What a powerful paragraph!! I am cheering for you!!

The value of investing in nursing